Most Common Brain Injuries in Babies Due to Hypoxia and Bleeding

MedicalResearch.com Interview with:
“Baby” by Victor is licensed under CC BY 2.0
Dr Chris Gale
Clinical Senior Lecturer in Neonatal Medicine
Imperial College London and
Consultant Neonatologist at Chelsea and Westminster Hospital
NHS Foundation Trust

 

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As part of a drive to make England a safer place to give birth, the Department of Health in England has set a target of reducing the number of babies that incur brain injury during or soon after birth by 20% by 2020 and to halve them by 2030.

Before now United Kingdom health services did not have a standard definition of brain injury in babies and there has been no systematic collection of data for this purpose. With colleagues and in collaboration with the Department of Health, we have devised a practical way to measure the incidence rate of brain injury in babies using routinely recorded data held in the National Neonatal Research Database.

The research estimated that 3,418 babies suffered conditions linked to brain injury at or soon after birth in 2015, which equates to an incidence rate of 5.14 per 1,000 live births. For preterm births (babies born at or less than 37 weeks) the rate was 25.88 per 1,000 live births in 2015, almost six times greater than the rate for full-term births, which was 3.47 per 1,000 live births.

Overall, the research found that the most common type of condition that contributed brain injuries was damage caused by lack of oxygen to the brain, called hypoxic ischaemic encephalopathy; this is seen mainly in term babies. For preterm babies, the largest contributor to brain injuries is from bleeding into and around the ventricles of the brain, a condition called periventricular haemorrhage.

It is also the first time that brain injuries in babies have been measured using data gathered routinely during day to day clinical care on NHS neonatal units. The use of routine data required no additional work for clinical staff and provides a valuable way to measure the effectiveness of interventions to reduce brain injury.

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Personality Changes Can Signal Incomplete Recovery After Traumatic Brain Injury

MedicalResearch.com Interview with:

Prof.dr. J van der Naalt PhD Department of Neurology University Medical Center Groningen Groningen, The Netherlands

Prof J van der Naalt

Prof.dr. J van der Naalt PhD
Department of Neurology University Medical Center Groningen
Groningen, The Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mild traumatic brain injury occurs frequently and is one of the leading cause of morbidity in adults worldwide. It is a major social-economic problem with one in three patients had persistent complaints several months after injury that interfere with resumption of daily activities and work.

One of the most important questions concerns the finding that some patients recover without complaints and others do not after sustaining a mild traumatic brain injury. In a follow-up study with more than 1000 participants we found that personality factors are a major factor in the recovery process. In particular coping, that is the way patients adapt to persistent complaints, is important next to emotional distress and impact of the injury.

In an add-on study with fMRI we found that in the early phase after injury, the interaction between specific brain networks was temporarily changed. However, when regarding persistent posttraumatic complaints , specific personality characteristics significantly determine long term outcome.

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New Biomarker Has Potential For Sideline Diagnosis of Traumatic Brain Injury

MedicalResearch.com Interview with:

Dr-Adrian-Harel.jpg

Dr. Adrian Harel

Dr. Adrian Harel, PhD
Chief Executive Officer
Medicortex Finland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Every 15 seconds, someone in the United States suffers a new head injury. Of the 2.5M people treated in hospital emergency rooms each year, 80,000 become permanently disabled because of TBI. Currently, there are no reliable diagnostic tests to assess the presence or severity of an injury on-site, nor are there any pharmaceutical therapies that could stop the secondary injury from spreading. Accurate diagnostics would benefit especially mild cases of TBI (concussions), which, if occurring repeatedly, may cause neurodegenerative conditions such as Chronic Traumatic Encephalopathy (which is typical for athletes in NFL and Ice-hockey).

We have performed extensive preclinical research comparing fluid biopsies from normal and injured lab animals. The results showed some unique biomarkers released as a biodegradation products after head injury. The data served as the basis and confirmation for our patent applications to protect the biomarker concept.

Medicortex has completed a clinical proof-of-concept trial in collaboration with Turku University Hospital (Tyks). Samples from 12 TBI patients and 12 healthy volunteers were collected and analyzed for the presence and for the level of the biomarker in state-of-the-art laboratories. The study demonstrated the diagnostic potential of the new biomarker in humans and it confirmed the prior preclinical findings. This was a significant milestone for Medicortex.

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When Is It Safe To Drive After a Concussion?

MedicalResearch.com Interview with:

Julianne Schmidt, PhD, ATC Assistant Professor Department of Kinesiology The University of Georgia Athens GA

Dr. Julianne Schmidt

Julianne Schmidt, PhD, ATC
Assistant Professor
Department of Kinesiology
The University of Georgia
Athens GA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Less than half of all people with a concussion intend to reduce their driving at any point.

Current recommendations surrounding concussion focus on when it is safe to return to sport or return to the classroom, but return to driving is usually ignored and has not been studied.
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Early Participation in Physical Activity Following Acute Concussion in Children

MedicalResearch.com Interview with:

Roger Zemek, MD, FRCPC Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario Ottawa, ON

Dr. Roger Zemek

Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit,
Children’s Hospital of Eastern Ontario
Ottawa, ON

MedicalResearch.com: What is the background for this study?

Response: While current concussion protocols endorse the conservative view that children should avoid physical activity until completely symptom-free, there is little evidence beyond expert opinion regarding the ideal timing of physical activity re-introduction. In fact, while rest does play a role in concussion recovery, protracted physical rest may actually negatively impact concussion recovery. Further, physiological, psychological, and functional benefits of early physical rehabilitation are observed in other disease processes such as stroke (which is an example of a severe traumatic brain injury). Therefore, our objective was to investigate the relationship between early physical activity (defined within 7 days of the concussion) and the eventual development of persistent post-concussion symptoms at one month.

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Depressive disorders are the most frequent neuropsychiatric complication of TBI

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge  MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist  Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury. Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients.

In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Sertraline May Prevent Depression Following Traumatic Brain Injury

MedicalResearch.com Interview with:

Ricardo E. Jorge MD Professor of Psychiatry and Behavioral Sciences Director Houston Translational Research Center for TBI and Stress Disorders Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry Michael E DeBakey VA Medical Center Baylor College of Medicine

Dr. Ricardo Jorge

Ricardo E. Jorge MD
Professor of Psychiatry and Behavioral Sciences
Director Houston Translational Research Center for TBI and Stress Disorders
Senior Scientist Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry
Michael E DeBakey VA Medical Center
Baylor College of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Depressive disorders affect between one-third and one-half of patients with traumatic brain injury (TBI). Once established, these disorders are difficult to treat and frequently follow a chronic and refractory course.

Depression has a deleterious effect on TBI outcomes, particularly affecting the community reintegration of TBI patients. In this randomized clinical trial that included 94 adult patients with TBI, the hazards for developing depression for participants receiving placebo were about 4 times the hazards of participants receiving sertraline treatment.

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Younger Kids More Likely To Quickly Return to Sports After Concussion

MedicalResearch.com Interview with:

Zachary Y. Kerr, PhD, MPH Sports Injury Epidemiologist Director, NCAA Injury Surveillance Program Datalys Center for Sports Injury Research and Prevention Indianapolis, IN 46202

Dr. Zachary Keff

Zachary Y. Kerr, PhD, MPH
Sports Injury Epidemiologist
Director, NCAA Injury Surveillance Program
Datalys Center for Sports Injury Research and Prevention
Indianapolis, IN 46202

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Kerr: A 2013 Institutes of Medicine report called for more research on concussion in athletes aged 5-21 years.  Although there is much research on the incidence of concussion across this age span, there is less related to outcomes such as symptoms and return to play time, let along comparisons by age.

In examining sport-related concussions that occurred in youth, high school, and college football, we found differences in the symptomatology and return to play time of concussed players.  For example, the odds of return to play time being under 24 hours was higher in youth than in college.  Also, over 40% of all concussions were returned to play in 2 weeks or more.

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Subtle Postural Control Changes In Some Soccer Players After Heading

MedicalResearch.com Interview with:

Jaclyn B. Caccese MS The University of Delaware PhD Candidate Biomechanics and Movement Science

Jaclyn Caccese

Jaclyn B. Caccese MS
The University of Delaware
PhD Candidate Biomechanics and Movement Science 

MedicalResearch.com: What is the background for this study?

Response: Recently, there has been increased concern regarding the adverse effects of repetitively heading soccer balls on brain function. While some studies have shown impaired balance and vision, it is unclear if these deficits are acute or chronic adaptations. Therefore, the purpose of this study was to identify changes in postural control and vestibular/ocular motor function immediately following an acute bout of 12 purposeful soccer headers.

MedicalResearch.com: What are the main findings?

Response: The main finding of this study was that women’s soccer players showed an increase in sway velocity, but no other changes in balance or vestibular/ocular motor function were identified.

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Blood Biomarkers Can Help Evaluate Mild Concussion

MedicalResearch.com Interview with:

Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP Director of Academic Clinical Research Attending Emergency Physician Orlando Regional Medical Center Professor, University of Central Florida College of Medicine Associate Professor, Florida State University College of Medicine Adjunct Professor, University of Florida College of Medicine Adjunct Professor, Department of Neurology and Neurosurgery McGill University

Dr. Linda Papa

Linda Papa MD.CM, MSc, CCFP, FRCPC, FACEP
Director of Academic Clinical Research
Attending Emergency Physician
Orlando Regional Medical Center
Professor, University of Central Florida College of Medicine
Associate Professor, Florida State University College of Medicine
Adjunct Professor, University of Florida College of Medicine and Department of Neurology and Neurosurgery McGill University

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Papa:  The temporal profile of these biomarkers has never been examined in mild TBI/concussion patients before. Research has focused on severe traumatic brain injury (TBI) but not enough work has been done in mild TBI/concussion. GFAP and UCH-L1 had very distinct temporal profiles in this study. It was a very pleasant surprise that GFAP performed so well and performed so consistently throughout the 7 days after injury. This suggests that GFAP could be used for clinical decision making over a week post-injury. The early peak in UCH-L1 was very exciting but its rapid decline will limit its use at later time points.

1-     The biomarkers could be used to detect a mild traumatic brain injury/concussion in patients following trauma acutely (GFAP, UCH-L1) such as in the emergency department or urgent care clinic or perhaps in the prehospital setting. Notably, GFAP could also be used later (up to 7 days) in patients who may not seek immediate medical attention.

2-     The biomarkers could help with determining the need for a CT scan of the brain acutely (GFAP, UCH-L1) or after several days (GFAP). This is particularly important in younger patients who are more sensitive to ionizing radiation. It also has implications for hospitals in rural settings who may not have access to CT scans 24 hours/day.

3-     The biomarkers could help identify patients who may need neurosurgical intervention very early after injury so patients could be transported to facilities where neurosurgical care is always available.

Some specific scenarios in which these biomarkers would be particularly helpful include:

  •    In patients who are intoxicated with drugs or alcohol (because they are cognitively impaired).
  •   In patients with polytrauma who have multiple injuries (other injuries distract from potential brain injury).
  •   In elderly patients who cannot express their symptoms or in children who cannot express their symptoms (we examined children in a separate study published in Academic Emergency Medicine in Nov 2015).
  •   In athletes with head trauma during play.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Papa:  These data focus on mild TBI/concussion patients. Getting blood samples from these patients over time is very challenging but is extremely important because individuals with mild TBI/concussion can present at different times after injury. Some patients do not seek medical attention for several hours to days after their injury. GFAP appears to be useful both early and late after injury. UCH-L1 is only helpful early on. This study captures the real-world setting in which  traumatic brain injury biomarkers would be used by comparing a large number of trauma patients with TBI to a large number of trauma patients without a TBI. This study provides physicians with information about when and how these biomarkers could be used to evaluate trauma patients with suspected mild TBI/concussion.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Papa:    These data provide valuable information on the diagnostic accuracy of GFAP and UCH-L1 at 20 distinct time points over 7 days after head trauma. They reflect severity of brain injury (higher levels indicate more severe injury). As with other blood tests, these biomarkers are tools to complement clinical judgment. 

MedicalResearch.com: Is there anything else you would like to add?

Dr. Papa:  Physicians have access to many blood tests for different organ systems in the body such as troponin for cardiac ischemia, creatinine for kidney impairment, TSH for thyroid function, etc…. As of yet, there is no FDA approved blood test for  traumatic brain injury . These results support GFAP as a robust marker for mild TBI/concussion. These blood tests are being commercialized for FDA approval.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Papa L, Brophy GM, Welch RD, et al. Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury.JAMA Neurol. Published online March 28, 2016. doi:10.1001/jamaneurol.2016.0039.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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